The state House's passage of the Medicaid bill moves it on to the Senate, where it faces a tougher fight, as Republicans hold a commanding 26-12 majority. / Thomas Gennara

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Detroit Free Press Lansing Bureau

Expanding Medicaid coverage to 470,000 low-income Michiganders was not an easy vote for many on the floor of the state House of Representatives on Thursday.

But in the end, the bill that would take advantage of an element of the Affordable Care Act passed the House by a 76-31 vote.

But it didn’t come without hours of private deliberations and public passions on both sides of the political aisle.

The bill was described as both a historic tool to get health care to Michigan’s most vulnerable residents and an unprecedented expansion of the federal government.

“I’ve been here 2½ years, but I can tell you this is the first day I’m really proud to be a representative in this state,” said state Rep. Brandon Dillon, D-Grand Rapids. “This legislation is the first time in a long time when we have rejected the extremes that too often define who we are. This legislation is controversial. It’s monumental.”

State Rep. Mike Shirkey, R-Clarklake, said he moved from a hard no to a yes vote with great trepidation.

“Despite the unsavory elements of expanding Medicaid in Michigan, despite the distastefulness of being remotely associated with something that’s been created in this nation that I really don’t like, the positives significantly outweigh the philosophical opposition,” he said. “I believe it’s time for us to stop playing defense with something that is the law of the land and begin playing offense. I’m convinced tonight that this is precisely what we need to do.”

Voting no was state Rep. Peter Lund, R-Shelby Township. “I just couldn’t get over the expansion part of it, and I’m very concerned about how it’s going to be paid for in the future,” he said. “It was a hard vote for every Republican. Nobody completely liked this bill.”

The vote came down to: 47 Democrats, 28 Republicans and one Independent voting for the expansion while 30 Republicans and one Democrat — state Rep. Scott Dianda, D-Calumet — voted against the bill.

“House approval of the Healthy Michigan Plan is a fiscally responsible, forward-looking move that puts our state on a healthier course” Gov. Rick Snyder said in a statement. “This is a Michigan plan for Michigan families, communities, businesses and our economy.”

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The plan to expand Medicaid health coverage now faces a tougher fight in the state Senate, where Republicans hold a commanding 26-12 majority with many GOP members adamantly opposed to anything associated with the Affordable Care Act.

That’s why the vote took so long to come by on Thursday as hour after hour passed with Republicans not wanting to take what could be a politically unpopular vote in their districts without assurances that the Senate would pass the bill, too.

The federal government will pay 100% of the costs of the expansion through 2017, and then the amount would decline to 90% by 2020.

The bill requires the additional recipients — those people who fall within 100% to 133% of the federal poverty level — to contribute 5% of their out-of-pocket medical costs. After 48 months, that co-pay would increase to 7%, or the recipient could purchase insurance on the health care exchange.

However, if a person who falls in that poverty level is deemed “medically frail” — either with a chronic disease, mental illness or an inability to complete the daily tasks of life — they would remain at the 5% co-pay.

At least 22 states and the District of Columbia are “moving forward” with plans to expand Medicaid, while Michigan and seven others continue to debate it, according to the Kaiser Family Foundation.

The Washington-based foundation tracks the implementation of the Affordable Care Act, and its researchers argue that Medicaid generally will save states money, in addition to offering health care coverage for millions of Americans currently uninsured.

The state House Fiscal Agency estimates that the expansion will save the state $206 million in its first year.

According to Kaiser, Medicaid expansion is not moving forward in 20 states.